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Saturday, December 25, 2010

I’ve lost 5 pounds since
Thanksgiving. Some people might liken this to a sort of Christmas
miracle. Others might brush it off as a general lack of nourishment and
exercise while studying for exams. But I’m a medical student. So I think
I have cancer. This is the funny thing about stuffing your head full of
facts on disease. You are exposed to so many ways your body can
malfunction that you become incredulous to the idea that anyone can actually be
healthy.

I think this is why
rheumatologists don’t run or play basketball. They’re afraid of getting
osteoarthritis and needing that bilateral knee replacement. And I have
yet to meet an ophthalmologist who wears contacts. Because there’s this pseudomonas
infection that eats through your cornea in 12 hours and leaves you blind.
Heck, I’m surprised Ob-gyns don’t just adopt. It may seem a little crazy,
but med school has a way of infusing some anxiety into every little ache or
pain.

I remember accidentally puncturing
the outside of my right ankle while cycling about 6 months ago. It was a
nice deep puncture, full of dirt and bike grease that oozed blood onto my
sock. I vividly recall worrying about all the tendons with funny Latin
names in that part of my ankle. Crap, did I slice my flexor digitorum
longus? But even as images of ankle anatomy flashed through my mind, my
more sensible inclinations took over, and I forced myself to rinse out the
wound, put on my shoe, and continue cycling.

Three days later, my foot swelled
up with infection. Now, I was sure I had necrotizing fasciitis. I
remember turning to my girlfriend, Tiffany, and telling her that I would need
my foot amputated, at which point she promised to still love me. But of
course, the infection went away with antibiotics. It turns out there was
no necrotizing bacteria, and I still have my right foot.

I think they warned me before
starting school that I would become a hypochondriac. I’m pretty sure our
dean even addressed this at our white coat ceremony. But at the time I
laughed it off, certain this only happened to the crazy kids. I didn’t
have to worry because I was level-headed and still fairly invincible. But
that’s the thing with studying tumors and tendons—you lose a bit of that
invincibility. So I guess I am susceptible to bouts of hypochondria after
all. But really what I’m worried about is this new bump on the back of my
head. Like I said, I think it may be cancer.

Saturday, December 4, 2010

When interviewing for medical
school, a student interview is often part of the hoop-jumping process. In these
interviews, they always ask you if you have any questions. I think you’re
supposed ask about stuff like research, curriculum, and the latest scholarly
article on treatment of disseminated intravascular coagulation. It shows
that you’re genuinely interested in medicine. During my interviews, I
always asked students if they were happy. Along with medicine, being
happy is one of my genuine interests.

Asking students about their
happiness earned me a good number of calculated smirks. Most students
would slip on this knowing grin before assuring me they were not miserable,
which was comforting, of course. There was, however, one student tour
guide who glared at me and flatly asserted, “We’re in medical school.” I
remember some of the applicants around me chuckling and even nodding. But
he was being serious and I don’t like to laugh at other people’s misery.

What transpires over the course of
years, or perhaps decades, that turns wide-eyed applicants into weary-eyed
professionals? None of us enter medicine with aspirations of becoming
jaded or cynical. I wonder if some of us just end up sacrificing too many
of our meaningful daily experiences under the piercing focus of our long-term
ambitions. True, we all sacrifice for the things we love. Medicine
is no different in this regard. But then again, as students we tend to
lay especially grand offerings of time and energy at medicine’s alter—trusting
that our intellect, emotion, and efforts are being poured into a worthy pursuit
(and trusting that this pursuit is nothing like a subprime mortgage).
What is sacrificed now will be reimbursed with interest later. At least,
that is our hope. Yet in our fury to get things done, joy often becomes
ancillary and delayed gratitude becomes a habit. Maybe even a way of
life. If foregoing happiness becomes our nature, how soon until it is
forgotten altogether?

I knew before entering medicine
that there would likely be holidays spent at the bedside of unhappy
patients. There will be attendings and residents who will chew me up and
spit me out for the least of my screw-ups. And on occasion, my textbooks
might not leave as much room on my bookshelf for poetry or comedy as I’d
like. Yet, in spite of all this, people before me have survived to smile
and tell jokes and some to even still laugh at them. It makes me think
that perhaps joy isn’t so much the result of choosing the right school, or even
the right specialty. Maybe it’s more of a skill, like inserting an IV or
stitching together a nasty wound. Sometimes you watch a skilled physician
perform a procedure with such ease that you forget the practice and effort
behind it. Maybe the same thing can be said about joy.

I have this theory that babies are
born with this unbridled capacity for joy and excitement, but perhaps as we get
older, cynicism starts to creep in as our ability to express joy with
child-like abandon simply atrophies with disuse. Really, I’d rather not
find out for sure whether the latter part of this theory holds any truth.
So I force myself to keenly cherish that last sip of coffee before I run out
the door, late for class in the morning. And I savor that bit of giddy
energy that dances in my stomach when a grumpy patient warms up to me after a
few minutes of conversation. I drink in the little moments of elation and
hold them on my tongue until they turn into euphoria. In the back of my
mind, I know I must for fear of ever becoming that student when asked if I’m
happy, can only respond “I’m in medical school.”

Tuesday, October 26, 2010

I interviewed a 27-year-old patient the other day who
was in pretty bad shape. I’ll call him Robby. Robby was a morbidly
obese Hispanic male who due to some health complications was suffering from
congestive heart failure in his mid-twenties. Congestive heart failure is
a condition where your heart doesn’t pump blood as effectively as it should,
and as a result, your body retains fluid causing generalized swelling.
You don’t often see it in twenty-something-year-olds. But here was Robby
with his normally heavy frame made even plumper by CHF. To put it
bluntly, he was a sad sight.

The first thing I noticed when I walked into Robby’s
room was the smell of stale urine. The next thing I noticed was that the
room was occupied by one of the largest human beings I have ever seen.
Now, everything in medicine has taught me to find compassion, set aside
preconceptions, and ignore unpleasant odors. Yet if I were truly honest
with myself, I would acknowledge that a small perhaps veiled part of my
consciousness could not completely block out the unkind prejudices that one
might associate with a foul-smelling, 300-plus-pound man.

Without a doubt, the nobler part of my medical student
being felt sorry for Robby. This part of my soul wanted to cry out
against the indignity of letting anyone to sit in his own filth. I
thought if I were a nurse, perhaps I would be the one kind enough to bathe
Rob—not so much to restore his hygiene, but to restore his dignity. After
all, I entered medicine because I believed in the goodness of restoration and
healing. But as always, our virtue is rarely left unperturbed by our
demons.

The darker part of my psyche balked at the physical
examination. Because taking a blood pressure might mean getting my
instruments dirty. And touching this patient might even mean soiling my
shirt sleeves. And while I am the first to pay lip service to compassion
for the broken and ailing, heaven forbid that I transfer anyone’s stale odor
onto my own hands. I hate this part of myself. Often, I am tempted
to pretend such feelings don’t lurk in the shadows of my consciousness.
But then I’ve always believed that darkness is galvanized when we ignore the
bit that resides in our own hearts.

I think there are people in this world who would look
at Robby and see nothing but a beautiful soul in poor health—saints among us
who know only compassion in its purest form. I have always admired these
people, especially when they happen to be physicians. And I never fail to
wonder whether their undiluted humanity was acquired somewhere in their
education and experience. Or are some people just born with a deeper well
of compassion?

I sat across from Robby, holding his thick arm in my
substantially smaller one, and I took his blood pressure. I ran my
fingers along his swollen ankles in search of a pulse buried in his puffy
feet. And I examined him as thoroughly as I possibly could, realizing
that I was not only learning to care for a patient, but I was hoping to wash
away a tiny bit of the sickness that swims in my own pulse. Because in my
more hopeful (or naïve?) moments, I think that I may one day be able to finally
exorcise that stubborn stench. Yes, maybe one day.

Wednesday, October 6, 2010

One of the crowning achievements
of all medical school admissions offices is their ability to assemble such a
brilliant collage of neurotic behaviors. Our test on the kidney is this
Friday, which means it’s exam week. Which also means my classmates and I
are finding creative ways to bolster our individual expressions of neurosis.

Many med students—perhaps myself
included—will generally stop sleeping during this electric week. Within
this group exists a rarer breed that begins purchasing double-caffeinated
espresso by the handle starting Monday morning (I think the Starbucks on our
campus is having a special this week). Still others give up shaving, or
bathing, or changing their clothes for a string of five or six days, spurning
hygiene in favor of multiple-choice glory. A rather common variation of
the anti-hygiene syndrome is the collapsible food pyramid. This is when a
med student foregoes the standard five food groups, essentially packing away
the beloved pyramid, with the aim of living out of boxes labeled “Nabisco” for
a few days. This is like camping. I think.

However, while the surface
expression of exam-induced neurosis can be quite variable, the pathognomonic
lesion is the Facebook update which cleverly indicates yes, I do indeed have an
upcoming test (especially a new status containing notions of how much/little I
am studying). For the sake of fulfilling this duty, I have written a
haiku:

The Kidney

Concentrates my pee

As my concentration vies

To
produce the most

Sometimes I joke that I applied to
medical school not because I wanted to become a doctor, but because I love
tests and I heard medical school had some good ones. Of course, this is
just me being facetious. But it is also probably 9.22% true. There, I confessed my
neurosis. Now I need to get back to studying.

Saturday, October 2, 2010

Over the summer, I picked up an
age-old practice that is popular among my peers. I started a “to-do”
list. It was one of those moments in early adulthood where I worry that I
am becoming an adult too early. But since medical school is brimming with
forms to fill out and meetings to attend, I grudgingly yielded some ground to
age in order to prevent schedules and errands from derailing my mind.
Plus, it gives me an excuse to own an iPod. It’s curious how tapping a
back-lit rectangular touch-screen is somehow infinitely more satisfying than
keeping a pen and pad. But I’ve realized something else in 2 months of
electronic list-keeping. Having a to-do list doesn’t guarantee anything
will actually get done. In fact, my list seems decidedly more effective at
highlighting (or back-lighting) all the things I don’t have time for.
Kind of like a chubby middle finger—with all the things I can never get around
to tattooed from nail to knuckle.

Some of the regulars on my list
include a pair of jeans that need tailoring, a tooth cleaning that requires
finding a new dentist, and an oil change for my car that is roughly 2000 miles
overdue. I think of these tasks as the loners who checked into my sad
motel of errands and never checked out. And the problem with housing such
tenants is that you never know which ones are going to turn out to be closet
psychopaths—introverts who never call any attention to themselves until one day
they set the entire establishment ablaze. Maybe I’ll get tartar buildup,
all my teeth will rot, and I won’t get into a good residency because straight
teeth and a good smile are the first things a residency director notices during
an interview. Maybe my car’s engine will explode while I’m cruising down
the freeway and they’ll have to shut down the 405 so rescuers can pry me out of
my self-inflicted burning wreck. Or maybe, I’ll get too fat for the jeans
I bought 3 months ago.

Aside from the undone errands, I
have also managed to partially embark on a handful of recreational
endeavors. Like the acrylic painting I started last Christmas. I
felt inspired to create after my girlfriend, Tiffany, and I went on a holiday
hike and took some beautiful pictures. Nine months later, I am the proud
owner of a half-inspired canvas which adorns the floor of my storage
closet. There’s also the novel I started reading this past summer, One
Flew Over the Cuckoo’s Nest. I got 90 pages into it before school started
8 weeks ago, and it’s been collecting dust on my nightstand ever since. I
am quickly entering that nebulous territory where if I don’t pick the book up
soon, I might as well start again from the beginning.

But among all the great
un-achievements I’ve amassed, the most disheartening are a handful of
aspirations I have long held but never appropriately addressed. Sure,
it’s nice to have healthy teeth, clean engine oil, and fitted jeans, but when
I’m old and broken, I can’t imagine thinking to myself “if only I completed
more errands.” No, the items most worthy of regret are always the ones
that don’t fit nicely on a to-do list. Things like travelling and
improving my Spanish, learning to rock out on the drums, and spending more time
exhaling as I swan dive into forward bend. Aspirations that have nothing
to do with due dates and everything to do with the character I hope to
embody. Sometimes, I wish they had taught me in first grade to accomplish
all my life goals before I turned thirteen. Because now I’m stuck
behind the eight ball wondering, will I be any closer when I am a working
physician? When I have kids of my own? When I’m senile, have
erectile dysfunction, and have forgotten to save up for retirement?
Exactly how swollen is this middle finger going to get, doc?

But even as I stumble, I try not
to lose heart. Because if medical school has taught me anything, it’s
that hope plays a key role in the therapy of all chronic conditions. It’s
what ailing patients say when you visit them—just one day at a time. It’s
a faith that in the midst of disease and deadlines, we’ll find space for the
things that are important, for the things we love. For me, this includes
writing. Writing to tell a story, writing to find myself, and writing for
no other reason than to finally check off an item that has been on my to-do
list for over 4 months. So at least for this moment, the swelling has
gone down just a bit, and this is a hopeful sign.

Thursday, May 6, 2010

I talked with my dad on the phone
for 30 minutes last night. 30 minutes. Probably not a big deal to most, but to
me, this was something of an anomaly. My dad isn’t much of a talker. Growing
up, the vast majority of our conversations began and ended with school, grades,
and standardized tests. This has been a trusty recipe for 30-second
conversations, especially since I’ve always managed to keep my academics more
or less in order. As I’ve gotten older, however, I’ve learned to pick up on my
dad’s preferred mode of communication—his actions and his hard work. His “I
love you” is an 80-hour work week and his “good job” is a split-second smile
and a nod—you might miss it if you haven’t learned to pay close attention.

When my dad learned that I wanted
to attend Duke for my undergraduate education, he told me that the price tag
for tuition could only be justified if I were to aim for medical school.
Otherwise, it simply “wasn’t worth it.” I knew that I really wanted to go to
Duke but I also knew very little about becoming a doctor. In the end, I agreed
to give the pre-med route a shot and that was my first decision to pursue
medicine. I know, not much of a decision.

Despite a general lack of interest
in most of what I was learning, I ended up doing pretty well in all my pre-med
classes. This didn’t give my dad much to talk about and it was a good thing,
sort of. However, I’ve learned that passion-less work will eventually catch up
with you in some shape or form. For me, it was burnout. By the time I had
finished my junior year at Duke and was gearing up to take my MCAT, I was
wiped. I was sick of the soul-draining cycle of stuffing information that I
didn’t care about into my head so that I could brain-puke it onto a test, so
that I could get the grade I wanted, so that I could go to my grad school of
choice, so that 20 years from now, I could perhaps be in a position I wanted to
be in. It was all too results-oriented. I realized that I couldn’t embrace the
journey because my initial decision to pursue medicine was rather uninspired. I
was good at the classes, I liked the idea of helping people, but it felt like I
was travelling smoothly, aimlessly down this default path, waiting for
lightning to strike.

And then I chose to pursue my
medical education at USC’s Keck School of Medicine, at which point my dad
basically told me to fuck off. This was after I spent a year working in an ER,
and deciding that I really did want to do medicine after all.
I think it really forced me to own up to this decision, the fact that my dad
hated it—not my decision to go into medicine, but my decision to attend Keck. I
was lucky to have garnered a few acceptance letters, and my dad felt that at
best, Keck should’ve been my third-choice option. Simply put, he had looked at
the U.S. News rankings, and to him it was rather clear. He didn't talk to me
for a month. In his eyes, it was love unreciprocated. He had done his duty,
working tirelessly so that I would have every opportunity. And now, he felt I
was abandoning my end of the bargain, foregoing his love. I have since gained a
better appreciation of the cultural overtones that led to my dad's actions and
from this I have found forgiveness. But at the time, I couldn't see much beyond
the pain and bitterness. There were nights I went to bed with murderous
thoughts.

It’s a funny thing when you choose
an unpopular stance on anything. You feel added pressure to perform, to
succeed, to avoid ever having to hear “I told you so.” And this is how I
embarked on my education at Keck. For the first many months, I wavered between
an inextinguishable fear that I had made a mistake and an unrivaled
determination to make the most of my experience. As the year went on, however,
these raw emotions began to dissolve into peace as I found myself enjoying my
experience at Keck. And not surprisingly, with this enjoyment came relief. It’s
been a transition, a challenge, a fulfillment. But more than anything, it’s
been the first time in a long time that I’ve enjoyed the process—the
journey independent of the destination.

So I talked to my dad last night
and per usual, we talked about school. He had heard from my mom that I was
enjoying medical school, and he expressed his pleasure. “You know,” he
chuckled, “it’s sort of a relief because I feel like I’m essentially the one
who forced you into medicine.”

He hummed to himself in muffled
agreement. Then after another brief chuckle, he brought up my White Coat
Ceremony, which he had attended at the beginning of the school year. “You
remember that—oh, what’s it called—that oath-thing you took?” He was referring
to the Hippocratic Oath. “I remember being moved.” He took a breath and his
tone deepened. “So, it looks like you are learning quite a bit, huh? I couldn’t
be more proud of you.”

I paused to let this translate. In
all the years I’ve known him, my dad has only said “I’m proud of you” one other
time. Like I said, my dad isn’t a man of many words and tough love is the only
kind he knows. But I’ve learned to read between the lines. Here he was, a year
after intensely fighting my decision to attend Keck, stating explicitly that he
was not only okay with it, he was proud.

I thought back to the Hippocratic
Oath my dad mentioned. I remember standing in front of the school my dad never
wanted me to attend and pledging a certain loyalty to “the profession of
Medicine and… its members” and accepting a certain responsibility “for the good
of the sick.” Now looking back, I think the Hippocratic Oath sums up pretty
well the fact that our decisions are steeped in the influence of
others—friends, teachers, patients, and parents. Our free will is inextricably
knotted to both those that come before us and to those that come after. But
even as we acknowledge the ways in which our characters and choices have been
molded by those around us, we somehow take ownership of our individual paths.
The day I stood up at my White Coat Ceremony and recited that oath was perhaps
the baptism marking when my journey in medicine—one that began with a little
coercion from my dad—fully became my own. And with a simple, rare “I’m proud of
you,” I felt my dad acknowledge this fact as well.

Thursday, February 4, 2010

I interviewed a medical school
applicant for the first time today. As a student-interviewer, I am supposed to
ask open-ended questions in order to develop an accurate impression of an
applicant. Basically, we are told to make sure there is a “real person” to go
with the shiny résumé that sits in the admissions office. This being my first
interview, I found myself struggling to formulate questions sharp enough to
probe the “realness” of the lady sitting in front of me. What the hell kind of
questions can you ask to penetrate the bullshit of interviews and reveal the
true substance behind a person’s character in 50 minutes? And if by some odd
play of fate I do elicit something meaningful and true, who the hell am I to
judge that which is unveiled before me? It all seems quite silly and random to
me—a microcosm of the entire medical school application process. This is why I
ask silly questions like “what do you think about healthcare reform” and “tell
me about your extracurricular activities.” It’s not that these questions aren’t
important. It’s just that part of me feels like the ringleader’s accomplice,
holding up another hoop for a tiger to jump through. This doesn’t tell you much
about the tiger except that it is beautifully-trained to perform circus acts.
Alternatively, if you want to know the true character of a tiger, you'd
probably be better off throwing some raw meat on stage.

This is the problem with the
medical school application process. It selects not so much for creative and
brilliant minds as it does for individuals with an uncanny ability to jump
through hoops. The Ringling Brother’s figured out that if you erected enough
flaming rings, you could easily raise up a pride of felines both talented and
tame enough to navigate a stunning barrage of obstacles. And in many ways,
medical schools have taken on this model. A med student is essentially the
Darwinian product of a countless number of unnatural forces, including
standardized tests, GPAs, research projects, volunteer work, recommendation
letters, two dozen short essays, soul-draining interviews, and expensive
business attire. This supposedly “weeds out” the faint of heart and leaves you
with a handful of elite specimens (minus the ones who figured out that law
school is only a 3-year commitment). However, the fact is that this process too
often leaves you with trained performers, a superb collection of conformists
all of similar color and trait. Great for the circus. Perhaps not so great for
the future of medicine.

It isn’t that medical students
aren’t wonderful, intelligent, and compassionate. Because from my experience,
they are—with little exception—all these things. But there is danger in
creating a generation of physicians, all pretty hues of vanilla like the lab
coats that they don. A homogenous group of leaders both in mind and motivation
is always at risk of perpetuating tradition over pursuing new ideas. This is
especially true when you consider that student physicians are masters at
manipulating their schedules, efforts, and intellect to fit success’s long
precedent. So while we may be great for shaking hands with the dean and rocking
the medical board exams, what creativity and innovation will we bring to
healthcare’s most daunting problems? Or will we stick to the script, put on a
show, and leave the next generation asking the very same questions—what do you
think about healthcare reform? Please, tell me about your extra-curricular
activities.